摘要目的:分析应用自体心包行主动脉瓣瓣叶扩大成形术治疗儿童主动脉瓣疾病的近中期效果。方法:回顾性分析2017年9月至2021年6月在阜外华中心血管病医院行自体心包主动脉瓣成形术的26例主动脉瓣疾病(狭窄或关闭不全)患儿的临床资料，收集近中期随访时资料，比较术前和术后主动脉瓣最大跨瓣压差、主动脉瓣下反流面积、左心室舒张末期容积(LVEDV)和左心室射血分数(LVEF)等相关指标，并采用配对 t检验分析自体心包主动脉瓣扩大成形术的近中期疗效。 结果:26例患儿手术均获得成功，术后随访无死亡和严重并发症病例，随访时间(22.96±6.45)个月。术后近中期主动脉瓣狭窄或狭窄合并轻中度关闭不全患儿中与术前主动脉瓣跨瓣压差比较，术后1个月( t＝7.85， P<0.05)、6个月( t＝6.43， P<0.05)、1年( t＝6.16， P<0.05)、2年( t＝4.22， P<0.05)差异均有统计学意义；单纯主动脉瓣狭窄9例患儿随访结果，术前舒张期主动脉瓣反流面积(8.87±3.57) cm 2，术后1个月、6个月、1年和2年主动脉瓣反流面积与术前比较差异均有统计学意义( t＝6.85、5.13、6.62、5.41，均 P<0.05)；26例患儿术前LVEDV(89.42±45.89) mL，术后6个月降至(63.54±27.61) mL( t＝3.89， P<0.05) ，术后1年降至(53.61±20.20) mL( t＝4.67， P<0.05)，术后2年(64.39±17.78) mL( t＝3.58， P<0.05)，左心压力和容量减小，增大的心脏缩小，心脏几何形态恢复；26例患儿术前LVEF(61.65±9.67)%，术后6个月升至(67.88±4.69)%( t＝3.68， P<0.05)，术后1年升至(68.62±4.46)%( t＝4.01， P<0.05)，术后2年升至(67.55±3.09)%( t＝3.01， P<0.05)，心功能较术前改善。 结论:应用自体心包主动脉瓣瓣叶扩大成形术后近中期疗效良好，可避免或延缓儿童主动脉瓣置换术。

abstractsObjective:To analyze the short and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases.Methods:A total of 26 children with aortic valve diseases (stenosis or regurgitation) who underwent aortic valvuloplasty with autopericardium in Fuwai Central China Cardiovascular Hospital from September 2017 to June 2021 were retrospectively analyzed.The short-term and mid-term follow-up data were collected.The maximum aortic valve pressure gradient, subaortic regurgitation area, left ventricular end-diastolic volume (LVEDV) and left ventricular ejection fraction (LVEF) were compared before and after operation.Paired t test was used to analyze the short-term and mid-term efficacy of aortic valvuloplasty with autopericardium on children with aortic valve diseases. Results:All 26 cases were successfully operated, and there were no deaths and serious complications during the follow-up period of (22.96±6.45) months.There was a significant difference between the preoperative and postoperative maximum aortic valve pressure gradient at 1 month ( t=7.85, P<0.05), 6 months ( t=6.43, P<0.05), 1 year ( t=6.16, P<0.05) and 2 years postoperatively ( t=4.22, P<0.05) in children with aortic stenosis or that combined with mild-to-moderate closure.The follow-up data of 9 children with simple aortic stenosis showed that there was a significant difference between the preoperative (8.87±3.57) cm 2 and postoperative aortic regurgitation area at 1 month ( t=6.85, P<0.05), 6 months ( t=5.13, P<0.05), 1 year ( t=6.62, P<0.05) and 2 years postoperatively ( t=5.41, P<0.05). The LVEDV of 26 children was significantly lower at 6 months[(63.54±27.61) mL], 1 year [(53.61±20.20) mL] and 2 years postoperatively [(64.39±17.78) mL] compared with that of preoperative level[(89.42±45.89) mL]( t=3.89, 4.67, 3.58, all P<0.05). The left ventricular pressure and volume decreased, the enlarged heart was narrowed down, and the geometry of the heart was restored.The LVEF of 26 patients also from (61.65±9.67)% before surgery increased to (67.88±4.69)% 6 months after surgery( t=3.68, P<0.05), and increased to (68.62±4.46)% 1 year after surgery( t=4.01, P<0.05), and increased to (67.55±3.09)% 2 years after operation( t=3.01, P<0.05), and the heart function was improved. Conclusions:Aortic valvuloplasty with autopericardium presents an effective short and mid-term efficacy on children with aortic valve diseases, which prevents or delays the aortic valve replacement.